study guide and self-assessment · is able to influence many of the body’s physiological ......

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Study Guide and Self-Assessment

2.1 The Relaxation Response

2.2 Autogenic Training

2.3 Anchoring

2.4 Image Visualization

2.5 Progressive Muscle Relaxation

2.6 Massage

2.7 Leaving It At the River

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Chapter TwoMind–Body CommunicationsMaintain Wellness

Learning Objectives

1. Describe three ways the mind and body communicate biologically.

2. Define psychosomatic illness.

3. Describe and give examples of the placebo effect.

4. Describe how faith, religion, and spirituality affect health.

5. Explain hypnotherapy.

6. Describe meditation and image visualization.

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26 Part One Achieving Wellness

Many people believe that good health is related primar-ily to proper nutrition and physical fitness. Whereasboth are vital to health, the most important factor thatdetermines your state of health is your mind. Positive

thoughts about yourself andothers and positive emotionssuch as contentment andlove contribute to vitality,optimism, and joy, which canmotivate living healthfully,aid healing and recoveryfrom illness and injury, and

increase longevity (Steptoe, Wardle, & Marmot, 2005).Negative thoughts and emotions contribute to depres-sion, pessimism, and decreased health and longevity(Astin et al., 2003).

In Western culture, we are accustomed to thinkingof health and healing in terms of drugs, medical treat-ments, and surgery. In other cultures, past and present,health and healing are accomplished by mentalprocesses such as faith, magic, and spiritual practices.Even in our culture we recognize that attitudes play animportant role in promoting health and recovering fromillness. All physicians are aware that a person’s attitudegreatly affects the probability of recovery from illness.We’ve all heard of “the patient’s will to live.”

The mind affects health and well-being because themind and body make up a single, unified organism. Nobody exists without a mind; no mind exists without abody. The mind and body communicate with each otherby means of the nervous, endocrine (hormone), andimmune systems, allowing thoughts, beliefs, and feel-ings to change body chemistry and physiology.

There are ways to focus the mind to promotehealth, prevent disease, and foster healing in times ofillness. Among them are biofeedback, relaxation, hyp-nosis, guided imagery, autogenic training, and medita-tion (Table 2.1). Recognizing their effectiveness, main-stream medicine has begun to utilize mind–bodytechniques, and researchers are elucidating the biologi-cal mechanisms that underlie mind–body communica-tions and their effects on health and wellness. In thischapter we discuss mind–body relationships and theircontributions to health and well-being.

Mind–Body CommunicationAdvances in identifying the biological mechanisms ofmind–body communication confirm that the mind canaffect health in powerful ways. Joy, creativity, and con-tentment lead to a state of mind–body harmony, whichwe experience as bodily health and subjective well-being. Fear, anxiety, stress, and depression contributeto mind–body disharmony, which increases risks for avariety of illnesses, impedes healing, and fosters asense that life is difficult and unpleasant.

Nerve cells in the brain’s thought and feeling cen-ters connect to other nerve cells in the brain and body,hormone-producing tissues and organs, and immunecells throughout the body. In this way, mental activityis able to influence many of the body’s physiologicalprocesses and maintain homeostasis (see Chapter 1).

A classic method for using the mind to alter bodilyfunctions is biofeedback. This method employs arecording device to facilitate learned self-control ofphysiological activities (see the following ManagingStress feature). The recording device is connected to aregion of the body (e.g., forehead, arm) and informationabout biological activity in that region is “fed back” on ascreen or by means of a sound to the person in whosebody the activity is taking place. Using this visual orauditory information about the activity, the person canlearn to control the activity in a desired way. Biofeed-back has been used successfully to treat more than 150medical conditions, including high blood pressure, backpain, panic attacks, and headaches (Mayo Clinic, 2006).Biofeedback also can be used to produce changes in thebrain’s electrical activity (alpha waves) to bring about astate of relaxation.

The Autonomic Nervous SystemA major way by which the mind and body communicateis through the autonomic nervous system (ANS), a groupof nerves that regulate many of the body’s physiologicalprocesses, such as heart rate, blood pressure, gastroin-

My granary burneddown.Now I can see thesun.Sufi saying

Table 2.1Mind–Body Methods for Promoting Health and Preventingand Recovering from IllnessMethod DescriptionAutogenic training Silent repetition of one of six autogenic

phrases to produce a state of deep

relaxation

Biofeedback Using an electronic device to “feed back”

information about the activity of a particular

region of the body to alter that activity

Guided imagery Using mental images suggested by a

“guide” to produce relaxation and/or

develop a skill

Hypnosis Focusing attention and lessening awareness

of surroundings to produce a relaxed state

that is open to suggestion

Image visualization Using self-generated mental images to

produce relaxation and/or develop a skill

Meditation Focusing awareness on a self-produced

inner sound (“mantra”), or an external

sound, or image, or one’s breathing to

lessen attentiveness to external stimuli

Progressive muscle Progressive tensing and relaxing of muscles

relaxation in the body to produce relaxation

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Chapter Two Mind–Body Communications Maintain Wellness 27

testinal activity, sweating, and elimination (Figure 2.2).Centers in the brain, principally the brain stem and hypo-thalamus, receive information about the state of the bodyand, in response, activate the nerve fibers of the ANS tomaintain appropriate physiological balance. For example,when you exercise, the ANS stimulates the heart’s pace-maker cells to increase your heart rate, thus increasingthe amount of blood pumped to moving muscles.

The autonomic nervous system derives its namefrom the fact that its activities normally operate with-out conscious control. Thus, you do not think abouthow fast your heart should beat or whether you shouldsweat to cool yourself when jogging. Even though theANS functions without conscious control, the signals itsends to the body can be affected by thoughts and feel-ings. For example, nearly all students are familiar withthe nervous stomach and sweaty palms that accom-pany taking an important exam. Realizing that it is pos-sible to do poorly on an exam (a thought) leads to anxi-ety (an emotion), which activates the ANS to producesymptoms. Panic has an immediate effect on breathingand heart rate, and stress can constrict blood vessels,causing headaches or high blood pressure.

Many students live fast-paced, hectic lives that arefull of time pressures and stress. Besides doing schoolassignments, many students work at jobs, and nearly alltry to maintain harmonious social relationships withfamily and friends, which take time and attention. More-over, the modern environment is filled with cell phones,

the Internet, TV, video games, iPods, and other stimulithat compete for one’s attention. Trying to accommodateall of life’s demands produces near continuous physio-logic arousal mediated by the sympathetic division of theANS, causing, among other things, sleep disturbances,muscle tension, gastrointestinal symptoms, and anincreased risk for cardiovascular disease.

Quieting the Autonomic Nervous SystemIt is possible to counteract ANS-mediated arousal by put-ting 20 to 30 minutes or more of quiet time into your lifeeach day. (If you must, schedule it in your day-planner).You can employ any of a number of techniques designedto lessen ANS arousal and create a sense of mind–bodyharmony (see Table 2.1). Or, you can find a quiet spot in apark or a room where you can comfortably and silentlyreflect on the good things in your life and let go for atime of the problems of the world and what you need to

BiofeedbackDan was a first-year graduate student who experienced

frequent headaches, for which he sought help from the

Student Health Center. Medical tests showed no brain

pathology, such as a tumor, or brain infection or injury.

Diagnosis: Dan’s headaches were related to the stress and

anxiety about doing well in graduate school.

Dan’s therapy involved meeting with a counselor to discuss

ways to manage the stress of graduate school and biofeedback

training to deal specifically with his headaches. In biofeedback

sessions, three small sensing devices, which monitored the

activity of the forehead’s frontalis muscle, were attached to

Dan’s forehead (Figure 2.1). The frontalis and certain muscles

in the neck involuntarily contract during times of stress, which

impedes blood flow to the head, resulting in a headache. Wires

from the three sensors were connected to a biofeedback unit,

which was placed on a table directly in Dan’s view. Whenever

Dan’s frontalis muscle contracted, the biofeedback unit

produced audible clicks. A very tense frontalis produced rapid

clicks. A relaxed frontalis produced infrequent, irregular clicks.

Dan was instructed by his biofeedback therapist to try to

reduce the number of clicks, a skill that required several

training sessions to attain. Paradoxically, not trying to relax his

frontalis produced the best results. The therapy proved

successful. Dan seldom got headaches. And when he did, he

could relieve them by relaxing the muscles in his forehead.

Managing Stress

Auditory (clicks)■

Sensors■

Visual display■

■ Figure 2.1BiofeedbackThe biofeedback device measures muscle tension in the head region.

The speaker produces rapid audible clicks when muscles are tense;

infrequent and irregular clicks when head muscles are relaxed.

T E R M S

autonomic nervous system: the special group of

nerves that control some of the body’s organs and

their functions

biofeedback: using an electronic device to “feed back”

information about the body to alter a particular

physiological function

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accomplish that day and in your life. Two methods witha body of research to support their effectiveness are therelaxation response and autogenic training.

The Relaxation ResponseThe relaxation response is an automatic physiologicalpattern opposite of autonomic nervous system activa-tion (Benson & Klipper, 2000). The relaxation responsedecreases oxygen consumption, respiratory rate, heartrate, blood pressure, and muscle tension. A variety ofmethods can produce the relaxation response, such asmantra meditation, progressive muscle relaxation, andguided imagery. For example, at the Harvard Medical

School, patients are taught to sit quietly and silentlyrepeat the word “one.” Methods that elicit the relax-ation response share these features:

• A quiet environment• A focusing of the mind’s attention, such as silently

repeating a word or phrase, or focusing one’sbreathing

• A passive, accepting mental state• A comfortable physical position

Autogenic TrainingAutogenic training uses autosuggestion to establish abalance between the mind and body through changesin the autonomic nervous system. The method hasbeen shown to be effective in relieving anxiety (Kanji,White, & Ernst, 2004) and improving the quality of lifein people with chronic medical conditions (Sutherland,Anderson, & Morris, 2005).

Autogenic training involves learning to concentrateon one of six basic autogenic phrases for a few minuteseach day for a week or more. After weeks or months ofpractice, one is able to attain a deep sense of relaxation,often within seconds, which can result in healthfulphysiological changes. The six basic autosuggestionsare as follows:

• My arms and legs are heavy.• My arms and legs are warm.• My heartbeat is calm and regular.• My lungs breathe me.• My abdomen is warm.• My forehead is cool.

Dilates pupils

ParasympatheticSympathetic

Dilates bronchi (lungs)

Dilates bladder

Inhibits salivation

Inhibits digestion(stomach, pancreas,liver, spleen)

Slows heartbeat

Inhibits adrenal gland

Constricts pupils

Constricts bronchi (lungs)

Contracts bladder

Stimulates salivation

Stimulates digestion(stomach, pancreas,liver, spleen)

Stimulates heartbeat

Stimulates adrenal gland

■

■

■

■

■

■

■

■

■

■

■

■

■

■

■ Figure 2.2Functions Controlled by the

Autonomic Nervous SystemThe sympathetic nerves and the

parasympathetic nerves regulate functions

that normally are not under conscious

control, such as breathing, digestion, and

heart rate.

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The exact phrasing of any autogenic suggestion is notcritical to its effectiveness. The words carry no particu-lar power. Any suggestion can be rephrased so that itbecomes comfortable, believable, and acceptable to thepractitioner’s mind.

HormonesBesides the autonomic nervous system, the mind canaffect physiology via the endocrine (hormone) system.Hormones are chemicals produced by special organsand tissues in the body. Each hormone regulates spe-cific biological functions (Figure 2.3). Hormones notifythe body of changes outside and inside the body thatmust be responded to in order to maintain health.

Many hormones respond to changes in thoughtsand feelings. For example, if the mind interprets a situa-tion as threatening or frightening, regardless of whetherthe danger is real or imagined, adrenalin and severalother hormones are released into the blood that makethe body alert and ready for action. The hormones bringabout an increased heart rate and mobilize stored nutri-ents to supply energy for dealing with the danger.

The Immune SystemBesides the ANS and endocrine system, the mind com-municates with the body via the immune system. Theimmune system (discussed in detail in Chapter 12) isresponsible for combatting infections and illness andridding the body of foreign organisms and toxic sub-stances. Immune system cells, tissues, and organs arelocated throughout the body. The immune system canbe influenced by the mind via the nervous andendocrine (hormone) systems. Nerves of the sympa-

thetic nervous system connect to certain immune tis-sues. Many immune cells respond to the presence ofthe hormone cortisol as part of the stress response (seeChapter 3). Moreover, the immune system releases spe-cial chemicals called cytokines, which can affect thenervous and endocrine systems.

That the mind can affect the workings of theimmune system is illustrated in a study of the effects ofmindfulness meditation on immune function in a workenvironment with healthy employees (Davidson et al.,2003). Volunteers were trained in mindfulness medita-tion for eight weeks, and at the end of training theywere vaccinated with influenza vaccine. Compared tononmeditating volunteers, antibody levels to theinfluenza vaccine were higher among meditators,demonstrating that mindfulness meditation producesmeasurable effects on the immune system.

The Mind Can Create Illness or Wellness

That thoughts and feelings can alter physiologicalprocesses means that individuals have powers to influ-ence their health for ill or for well-being.

T E R M S

autogenic training: the use of autosuggestion to

establish a balance between the mind and body

through changes in the autonomic nervous system

hormones: chemicals produced in the body that

regulate body functions

relaxation response: the physiologic changes in the

body that result from mental relaxation techiques

Using Your Mind to Heal Your BodyEveryone has accidentally cut or burned his or her hand at one

time or another. Perhaps you were chopping vegetables and

the knife slipped, or perhaps you reached for a pan on the

stove, forgetting that the handle was hot. The usual response

to such accidents is anger at being careless or forgetful and

anger at the sudden pain. We jump around, curse, and

generally act in ways that exacerbate the injury and delay

healing. A much better response to minor accidental injuries

that do not require immediate medical attention is the

following.

In case of a cut, place a clean cloth over the wound and

press gently to help stop the bleeding.Then sit or lie down.

Close your eyes and allow yourself to become mentally and

physically quiet. Visualize the injured part with your mind and

see it as it was just before the accident. See the skin coming

back together. Feel the pain recede. Notice that there is no

bleeding. Continue doing this for five minutes or longer until

you feel calm. If the accident caused a burn, place an ice bag or

cool, wet cloth over the wound.Then lie down and visualize the

skin becoming cooler and looking like the normal skin around

the burn.

By immediately calming the mind after an injury,

inflammation and other harmful physiological reactions in the

area are reduced. Healing processes begin immediately when

you send positive, calming thoughts and images to the injured

area. Continue to visualize healing in the injured area.

Wellness Guide

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Psychosomatic IllnessesThe power of the mind to create illness is illustrated bypsychosomatic illnesses, also called psychophysiologi-cal disorders (Figure 2.4). These conditions are causedby negative mental states and attitudes, such as anxi-ety, depression, and stress, that harmfully change bodyphysiology, hence the description psych (mind) andsoma (body).

Many people believe that psychosomatic meansimaginary, that “it’s all in the head.” This is not the case.The damage to the gastrointestinal tract in someonewith stress-related irritable bowel syndrome is just asreal as the damage caused by an infection. Psychoso-matic means that thoughts and feelings are at the root ofthe physiological abnormalities causing the symptoms.

Modern medicine (see Chapter 19) tends not to man-age psychosomatic illnesses directly. Physicians tend tooffer drugs to suppress symptoms, but rarely do theyaddress the underlying mental states that cause the ill-ness. This is caused in part by their training, whichfocuses on biological causes of disease, and in part bydoctors not having time to probe the lifestyle of apatient with a psychosomatic illness; also the patient’shealth insurer is not likely to pay for the doctor to do so.

Somatization DisordersSomatization refers to the occurrence of physicalsymptoms without the presence medically of detectableinjury or disease. Psychological and social problemssuch as depression and hostility may cause pain,fatigue, nausea, diarrhea, and sexual and other prob-lems. It is estimated that 25% to 75% of all patients whovisit primary care physicians suffer from somatizationdisorders. These are difficult to treat, time-consumingfor physicians to diagnose, and expensive for the healthcare system. The diagnostic criteria for a somatizationdisorder are shown in Table 2.2; the chief complaint ispain of long duration in several parts of the body thatcannot be explained by any medical condition or injury.

The lives that many people choose to live or areforced to live by financial or family circumstances cancause mind–body disruption that eventually producespain and sickness. People suffering from somatizationdisorders are not feigning sickness; they have lostmind–body harmony to a serious degree.

The Mind Can Create WellnessThe power of the mind to create wellness is illustratedby studies that show that positive emotions are associ-

Parathyroids (dorsal)

Adrenals

Ovary

Hypothalamus

Pituitary

Thyroid(ventral)

Pancreas

Testis

■ Figure 2.3Where Hormones

Are ReleasedHormones are released

from different glands

throughout the body.

The synthesis and release

of these hormones are

regulated by the mind

and autonomic nervous

system. Hormones carry

chemical messages that

tell organs in the body

how to respond to

stimuli.

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ated with healthful biological changes. For example, agroup of English civil service workers were asked to ratetheir state of happiness several times during a typicalwork day while researchers measured blood pressure,heart rate, and stress hormone (cortisol) levels (Steptoe,

Wardle, & Marmot, 2005). Those with the highest happi-ness ratings showed the lowest heart rate and stresshormone levels (there was no effect of happiness onblood pressure).

Humor can have a positive effect on health (Christie &Moore, 2005). Humor increases comfort levels anddecreases stress and anxiety in patients with cancer.Humor has a positive effect on the immune system by ele-vating natural killer cells (Bennett etal., 2004). Humor alsoimproves pain thresholds, perhaps by activating endor-phin release in the brain.

The importance of humor on health was recognizedas far back as ancient Greece. Plato was a strong advo-cate of humor as a means to lighten the burdens of thesoul and to improve one’s state of health. Frommedieval court jesters to circus clowns, humor has longbeen a factor influencing mind–body healing. Only nowis medical science learning what people have known

T E R M S

psychosomatic illnesses: physical illnesses brought on

by negative mental states such as stress or emotional

upset

somatization: occurrence of physical symptoms

without any bodily disease or injury being present

somatization disorder: prolonged pain and other

symptoms that are not caused by disease or injury

Tension headaches

Hyperactive thyroid

Erection problemsin men/menstrualproblems in women

Bruxism (grinding of teeth)

Eczema

Back pain

Tinnitus (ringing in one or both ears)

Acne

Bronchial asthma

Essential hypertension

■

■

■

■

■

■

■

■

■

Rheumatoid arthritis■

■

Ulcerative colitis■

Irritable bowel syndrome■

■ Figure 2.4Psychosomatic IllnessesMany diseases and disorders of the body are

partly caused by thoughts and feelings.

Table 2.2Diagnostic Criteria for Somatization DisorderA. History of physical complaints begins before age 30, lasts for several

years, and results in the request for treatment or in significantly

impaired social, occupational, or other types of functioning.

B. Each of these four criteria must be met, with individual symptoms

occurring at any time:

1. History of pain related to at least four sites or functions

2. History of at least two gastrointestinal symptoms other than pain

3. History of at least one sexual or reproductive symptom other than

pain

4. History of at least one symptom or deficit suggesting a neurologic

condition not limited to pain (a conversion symptom, a dissociative

symptom, or loss of consciousness other than fainting)

C. One of these two criteria must be met:

1. Symptoms in B cannot be explained by a medical condition or the

effects of a substance.

2. When there is a related medical condition, the physical complaint

or the resulting social or occupational impairment is in excess of

what would be expected from the history, physical examination,

or laboratory findings.

D. Symptoms are not intentionally produced or feigned.

Source: American Psychiatric Association. (1994). Diagnostic and statistical

manual of mental disorders (4th ed.). Washington, DC: Author. Copyright 1994,

American Psychiatric Association. Reprinted with permission.

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intuitively for centuries—laughter is good medicine.(See the Managing Stress feature on humor therapy onpage 34.)

Mind–Body HealingPlacebo EffectThe placebo effect is the lessening of symptoms or cur-ing of disease by believing in the healing powers of amake-believe medicine or “sugar pill.” Although thecurative powers of placebos are based on the recipient’sbelief in their power, that is not to say that the placeboeffect is not real. Placebos act on the mind, whichbrings about physiological changes.

The placebo effect is so common and powerful thatbefore being approved for use, the U.S. Food and DrugAdministration requires that a new drug undergo a double-blind, placebo-controlled trial. This means comparing onegroup of patients’ responses to a new drug with a differ-ent, matched group’s responses to a placebo (the controlgroup). So as to minimize bias, people in the test-druggroup and the placebo group do not know which sub-stance they are receiving, that is, they are “blind.” Further-more, none of the scientists administering the test drug orthe placebo knows what the patients are receiving, that is,they also are “blind.” Only the project administratorknows who is receiving what. The efficacy of the newdrug is determined by its performance compared to theplacebo.

The placebo effect has been found to occur in thetreatment of ulcers, postoperative pain, seasickness,headache, coughs, rheumatoid arthritis, blood cellcounts, hay fever, hypertension, and warts. The numberof people responding to placebos for any kind of symp-tom ranges from 30% to 70%; most studies report abouta 50% response. Thus, for almost any disease or symp-tom, a person has about a 50% chance of improvementby believing in the power of the treatment whether ornot the treatment has any specific biological effect onsymptoms.

Depression is a condition in which the placeboeffect can account for as much as 75% of any reliefexperienced. Figure 2.5 shows the results of a studycomparing two antidepressant drugs with a placebo pill.Notice that during the first three weeks of the study,depressed individuals got almost as much relief fromthe placebo as from the antidepressant drugs. Why thebenefits of the placebo did not increase after that timecould be a result of differences in the rates at which theantidepressants and the placebo were eliminated fromthe body or subtle chemical effects in the brain pro-duced by the antidepressant drugs. Nevertheless, asdemonstrated in this study, the placebo effectaccounted for 60% to 70% of the relief.

To determine how the placebo effect could be oper-ating to relieve depression, researchers used positron

emission tomography (a PET scan) to visualize the activ-ity in different regions of the brain when depressedindividuals received antidepressant medication orplacebo (Mayberg et al., 2002). The results showed thatthe pattern of brain activity of patients receivingplacebo was almost the same as those receiving antide-pressants. Apparently, the expectation that their symp-toms would improve caused biological changes in thebrain that contributed to relief of depression.

Pain responds exceptionally well to the placeboeffect (Figure 2.6). As with depression, pain relief fromplacebo can occur from biological changes in the brain.For example, researchers used functional magnetic res-onance imaging (fMRI) to map changes in blood flow inthe brains of volunteers (Wager et al., 2004). The volun-teers were subjected to harmless but occasionallypainful electric shocks or heat. When they believed ananti-pain cream had been applied to their arm, theyrated the pain as less intense. Moreover, placebo painrelief was related to decreased brain activity in pain-sensitive brain regions and was associated withincreased activity during anticipation of pain in otherbrain regions, providing evidence that placebos alter theexperience of pain.

A different study showed that placebo-induced painrelief might occur because the expectation of relief ofpain might be changing the body’s manufacture orrelease of its own internal pain-reducing chemicals,called endorphins (Christensen, 2001). After having wis-dom teeth removed, adults were given morphine orplacebo for pain relief; about 33% of those receivingplacebo experienced pain relief. Then, a chemical thatblocks the effects of morphine and endorphins, called

50%

100%

75%

25%

0%Baseline 1 2 3 4 5 6

n = 39n = 33n = 47

VenlafaxineImipraminePlacebo

Time (Weeks)

Clinic

al Gl

obal

Impr

essio

ns Sc

ale%

Patie

nts R

espo

nding

■ Figure 2.5Placebo StudyA double-blind, placebo-controlled study comparing two antidepressant

drugs, venlafaxine and imipramine, with placebo in reducing the

symptoms of clinical depression. (n is the number of patients in each

group.) For at least one month, just as many patients received relief of their

symptoms with a placebo as with either antidepressant drug.

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naloxone, was given to any patient who had experi-enced pain relief, either from morphine or placebo. Allpatients receiving naloxone experienced return of theirpain. Thus, it would appear that the expectation of painrelief can stimulate the manufacture and release ofendorphins.

Why, if placebos are so effective in healing, are theynot used more by physicians in treating patients? Onereason is an ethical dilemma for physicians: A placebomight work for one patient but not for another.Although the same could be true for a prescribed drug,the physician is protected legally by prescribing a drugthat has been clinically tested and approved by theFDA. However, no legal protection exists for a physicianprescribing a placebo if the patient decides to sue,claiming that the treatment did not meet acceptedmedical standards.

Yet another reason that placebos are not part ofmedical practice is that placebos can be dangerous, justas drugs can be dangerous. Patients can becomeaddicted to placebo pills used for pain relief and sufferwithdrawal symptoms when they stop using them.Also, like prescription drugs, placebo pills can causeside effects. In one experiment, 40 volunteer asthmaticpatients were asked to inhale a placebo spray, whichthey were told contained an allergen. Twelve of the vol-unteers had full-blown asthma attacks, and seven hadlesser symptoms. The asthma attacks were reversed byinhalation of another placebo spray, which they weretold would relieve the symptoms.

Words can produce a placebo effect in the sameway as a pill. Because of this fact, you should alwaysseek out health practitioners whom you trust and whouse positive, constructive healing suggestions and who

encourage you to become involved in self-healing prac-tices. Avoid health practitioners who voice negative andpessimistic recommendations. No one needs to hearnegative suggestions such as, “You’ll probably have totake these pills for the rest of your life,” or “I doubt thatyou’ll be able to move around much after an accidentlike that.” In the presence of a physician many patientsbecome very open to suggestions, both positive andnegative, because their minds are intently focused onwhat the doctor is saying. Such a focused state of mindis similar to that obtained in meditation or hypnosis. Itis more helpful to practice being alert and critical whendiscussing your health concerns or diagnostic testresults with a health professional. Of course, this is notalways easy to do, especially when the informationbeing conveyed causes distress or fear.

A tragic, but dramatic, example of mind–body com-munication and the power of a negative placebo effectinvolved a patient who died apparently from reading asingle word (Hewlett, 1994). This person had a history ofchronic lymphatic leukemia, a form of blood cancerthat usually is easily controlled with drugs. The patienthad been well for more than three years with onlyintermittent need for medication. However, he hadnever actually been informed of the original diagnosisof his condition.

One day he was in his physician’s office on a rou-tine visit and happened to read the physician’s notes,which were laying on the desk. He saw the wordleukemia in his file. He missed his next scheduled officevisit and shortly thereafter showed up in the hospital’semergency room. Within three weeks he died in thehospital. No cause of death could be discovered atautopsy, and his leukemia was still in remission. Thepatient apparently believed that he had terminal cancerjust from seeing the word leukemia in his medicalrecords. The mind does heal; the mind does kill.

Faith and HealingThousands of years ago the priest–healers of ancientcivilizations and the shamans of native tribes used thebeliefs of their people to heal by incantation, to exorciseevil spirits, and to vanquish demons who were thoughtto cause disease. The existence of shamans, faith heal-ers, and medicine men and women in cultures through-out human history suggests that their healing methodsmust have been generally successful. Egyptian papyri

50%

100%

75%

25%

0%0.5 1 2 3 4 5 6

n = 602n = 618

Excedrin ESPlacebo

Hours

Resp

onde

rs (%

)

■ Figure 2.6Double-blind, placebo-controlled study comparing Excedrin and placebo

in relieving the pain of migraine headache. A responder is a patient with

moderate or severe pain whose pain was reduced to mild or none

following treatment. Note that more than half of over 600 patients with

migraine headache had mild or no pain after taking a placebo pill.

T E R M S

placebo effect: healing that results from a person’s

belief in a treatment that has no medicinal value

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show that although the priest–physicians of ancientEgypt prescribed herbs and performed surgeries, theirtreatments relied on the belief of the people in the heal-ing power of the gods. Priests would put patients into atrance in a temple and tell them that when they awak-ened, they would be healed. And often they were.

The Greeks and Romans also had gods, oracles, andtemples of healing. Their priests also used trance andsleeplike mental states to impart healing suggestions to

receptive minds. Sometimes“miraculous cures” resulted.Greek and Roman emperorsand priests also healed bythe “laying on of hands”;people were healed becausethey believed that their

rulers had divine powers. King Pyrrhus of Epirus isreputed to have cured sick patients solely by the touchof his big toe.

All religions teach that divine persons have thepower to heal. The New Testament recounts manyexamples of the healing power of Jesus.

Is any sick among you? Let him call for the Elders ofthe church and let them pray over him, anointing himwith oil in the name of the Lord; and the prayer offaith shall save the sick.

—James 5:14–15

That evening they brought him many who werepossessed with demons, and he cast out the spiritswith a word, and healed all who were sick.

—Matthew 8:14

And he said to her, “Daughter, your faith has made youwell; go in peace and be healed of your diseases.”

—Mark 5:34

Over the centuries, faith and prayer have healed manypeople. Some ascribe healing to the power of God; oth-

Repeating This Phrase May ImproveYour HealthIn the early 1900s, a French pharmacist named Emile Coué

(1857–1926) became famous for using autosuggestion to

cure people of all kinds of ailments. His most famous

autosuggestion, which millions of people recited to

themselves, was: “Every day, in every way, I’m getting

better and better.”

Try this autosuggestion or make up one of your own to

fit a particular situation you want to improve. Repeat the

suggestion in your mind as often as feels comfortable. Do it

without effort or expectation. Autosuggestion is a powerful

tool for improving health and solving problems.

Health Tip

Faith. You can dolittle with it andnothing without it.Samuel Butler

Humor TherapyIt’s true that laughter is the best medicine. On average, the

typical person laughs about 15 times per day. This number can

shrink dramatically, however, when people are influenced by

emotions such as anger, fear, or grief. Just as unresolved

emotions can ultimately have a negative effect on the body,

positive emotions can also influence our state of health.

Thanks to the pioneering work of Norman Cousins and

others who have followed in his footsteps to develop the field

of psychoneuroimmunology, we know that our emotions can

trigger physiological responses, including the release of special

neuropeptides, which seem to have a healing effect all their

own. The result of several bouts of laughter can actually bring

about a sense of homeostasis to help calm the body and, in

effect, bring a sense of inner peace.

The real message of humor therapy is that we must learn to

establish a sense of emotional balance, to feel the range of

feelings—anger, fear, joy, love, and so on. Shortly before he

died, Norman Cousins said that it wasn’t humor that healed

him; it was love. Humor, he said, was a way in which

compassion could do its healing work.

Here are some ways to tickle your funny bone and get your

quota of 15 laughs per day.

1. Create a tickler notebook of cartoons, stories, photographs,

and other items that bring a smile to your face. Refer to it

often, especially when you’re down in the dumps.

2. Walk into a greeting card shop and buy five of the funniest

cards you find.

3. Tell a close friend the most embarrassing event that has

ever happened to you.

4. Buy 10 red roses and go to the nearest hospital or nursing

home and distribute them to the first 10 people you see.

5. Over the weekend, go to a video store and pick up some

comedy videos. Have a humorfest at home.

6. Read a funny novel.

7. Listen to a comedy audiotape or CD.

8. Hang out at a children’s playground and watch little kids

play for a half hour.

9. Fill your tub with hot water, bubble bath, and a rubber

duck. And play!

10. Call some old friends you haven’t talked to in a while,

catch up on their lives; tell them a funny joke; then tell

them you love them.

Managing Stress

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ers explain it by the power of belief in producing aplacebo effect.

Today’s patients have faith in the knowledge oftheir physicians and the drugs they prescribe just aspeople of ancient civilizations believed in their priestsand herbs. The improvement in any patient’s conditionis a combination of faith in the healer and the efficacyof the treatment.

Spirituality, Religion, and HealthMany people believe that spirituality—finding meaning,hope, comfort, and inner peace through religion, a con-nection with Nature or some force larger than oneself—plays a role in health and illness. One study (MacLeanet al., 2003) found that 66% of individuals want theirphysicians to be aware of their spiritual or religiousbeliefs. However, most individuals do not want theirphysicians to be directly involved in their health-relatedspiritual experiences. For example, only about 20%want their doctors to pray with them in routine officevisits; about 50% want their doctors to pray with themin a hospitalized, near-death situation. A survey of doc-tors showed that 95% believed a patient’s spiritual out-look was important to handling health difficulties and68% believed that physicians should ask patients aboutspiritual and religious issues (McCauley et al., 2005),although few physicians believe that it is appropriatefor them to recommend prayer and religious activitiesto patients (Sloan et al., 2001).

Many people believe in the healing power of prayerand the capacity of faith to help them prevent andrecover from illness. For example, compared to infre-quent or never-attenders, people who attend religiousservices at least monthly were found to have a 30% to35% reduced risk of death (Musick, House, & Williams,2004). The positive effect on health of religious atten-dance is associated with healthier lifestyles (especiallyengaging in physical activity), increased social relation-ships, and stable marriages (Strawbridge et al., 2001).These factors may be responsible for the finding thatweekly religious attendance is associated with ahealthy immune system (Lutgendorf et al., 2004).

For centuries, science and religion provided separateways of understanding the world. By definition, religiousexperience or the claims of religions cannot be tested byscience because they are not subject to experimentationor reproducibility. With the development of new brainimaging techniques, however, spiritual experiences andbrain electrical activity have become accessible to scien-tific investigation. The new field, called neurotheology,has shown that in brains of persons deep in prayer ormeditation, visible structural changes occur (Begley,2001). When people experience a “cosmic unity, loss ofself, or perception of God,” brain activity is altered, par-ticularly in a region called the temporal lobe. On reflec-tion, it is not surprising that a strong spiritual experienceis reflected in altered brain activity, just as a strong emo-tional experience is. What probably will never beanswered is whether brain activity creates the mysticalexperience or whether the mystical experience has areality of its own that occasionally is perceived by ahuman brain. As the Buddhist koan asks, “If a tree falls inthe forest and no one hears it, does the fallen tree exist?”

Spiritual experiences tend to engender feelings ofcompassion and empathy; peace of mind; relatednessand communion with a force, power, or set of valueslarger than oneself; and harmony with the environ-ment. These feelings are believed to be a cornerstone ofhealth because they represent a balance between theinner and outer aspects of human experience. Forsome, the spiritual dimension of life is embodied in thepractice of a specific religion. For others, the spiritualdimension is nonreligious and simply part of a personalphilosophy. Many practices can help people experiencethe spiritual realms of existence—prayer, meditation,yoga, musical and artistic endeavors, and helping oth-ers are but a few common ones.

Becoming more spiritually aware, regardless of thechosen path, can lead to a healthier life. Being in touchwith your spiritual feelings helps you handle life’s upsand downs with understanding and compassion for your-self and others. You become open to love in the highestsense of its meaning, which is acceptance and tolerance.You begin to love yourself despite your problems and

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hang-ups. You love your family and friends when rela-tions are strained. You seebeauty and harmony in moreand more aspects of living.And occasionally—however

fleetingly—you may experience the truly wondrous feel-ing of being completely and joyfully alive.

Hypnosis and HealingThe modern use of hypnosis as a medical techniquebegan with the Viennese physician Franz Anton Mes-mer, who practiced in the late eighteenth and earlynineteenth centuries. History has preserved the termmesmerism for the trancelike state that Mesmer pro-duced in his patients. Many years later, a Scottish physi-cian, James Braid, introduced the term hypnosis (fromthe Greek hypnos, meaning sleep) and began to practicehypnotherapy, the use of hypnosis to cure sickness.

Mesmer called his technique for healing “animalmagnetism” because he had his patients hold onto metalrods that supposedly transmitted healing energy whilethe patients were in trance. Mesmer was so successfulthat other physicians in Vienna forced the authorities toorder him to stop using his unorthodox methods. In 1778,Mesmer moved to Paris, where he again was successful inattracting patients. Eventually, the French authoritiesappointed a scientific panel, which included BenjaminFranklin (U.S. ambassador to France at the time), to inves-tigate Mesmer and his methods. The panel concludedthat there was no scientific basis to animal magnetismand that Mesmer was a fraud. This conclusion wasreached even though the panel did not dispute Mesmer’ssuccess in curing many patients. Discredited by physi-cians and scientists, Mesmer died in obscurity in 1815.

Despite being officially discredited, mesmerism(now called hypnotism) flourished throughout England,Europe, and the United States in the nineteenth cen-tury. In 1847, J. W. Robbins, a Massachusetts physician,reported using hypnotherapy to treat eating disordersand to help people stop smoking. Dr. Robbins used aver-sive suggestions while patients were in trance and alsogave them posthypnotic suggestions. Many of the sameprocedures are used today in treating these and otherbehavioral disorders.

In the late nineteenth century, two French physi-cians showed that healing could be accomplished solelyby suggestion and that cures resulted from the patient’sexpectation of being cured. Hippolyte-Marie Bernheim,who used hypnotherapy successfully with thousands ofpatients, argued that almost all healing resulted fromsuggestions he gave receptive patients while they werein trance.

Effective use of suggestion in healing seems todepend on the degree of mental relaxation involved. For

reasons that are not entirely clear, a mind engaged inthe conscious thoughts of daily living is not as open tosuggestion as one that is internally relaxed by hypnosis,meditation, or other mental relaxation techniques.

Understanding Hypnosis May Help You RelaxTo study hypnosis, researchers must have a way ofmeasuring the hypnotic state. A series of suggestibilitytests that consist of a 12-point scale were developed bypsychologists at Stanford University in the 1950s. A lowscore means that the subject does not enter a state ofhypnosis; a high score means that the subject is highlysusceptible to hypnosis. Most people score between 5 to7 on the Stanford test, which is still used by researcherstoday (Nash, 2001).

Many people have fears about being hypnotized, andmany myths about hypnosis still exist. Perhaps the great-est fear people have is that they can be forced to do some-thing terrible or evil if they are hypnotized. This view wasgreatly reinforced by the popular film The Manchurian Can-didate, which showed hypnotized people who were pro-grammed to kill when given a verbal command by thehypnotist. Other people feel that they will lose their moralvalues if they become hypnotized, but this also is nottrue. Some of the misconceptions and apprehensionsabout hypnosis are summarized in Table 2.3.

Hypnotherapy is potentially a valuable adjunct tomedical practice and has a long and successful history.It is not used widely because of time constraints andthe almost universal belief that the right pill will cureeverything. Physicians have to take time to develop arapport with patients and be willing to take as muchtime as necessary to answer all questions and makesure the patient is comfortable with being hypnotized.Modern medical practice does not allow for this in anage of managed care and HMOs (see Chapter 19). Timeis money in modern medical practice.

Virtual Reality TherapiesIt has been known for many centuries that distraction is avery effective treatment for pain. That is why medita-tion, hypotherapy, prayer, and other methods that focusthe mind’s attention on something other than pain areso effective. Many Buddhist monks and devout individu-als of many faiths learn to focus their attention so com-pletely on a mantra, mandala, breathing, or exaltedinner state that they are, quite literally, “out of theirbodies.” Modern medical researchers are using thisaspect of mind to create virtual reality therapies to treatburns, pain, phobias (e.g., fear of flying or heights), fearof public speaking, and even survivors of the 9/11 attackwith posttraumatic stress disorder (see Chapter 3)(Thacker, 2003).

Anyone who has seen the film Matrix or plays videogames knows that virtual reality involves focusing one’s

We do not see thingsas they are. . . . Wesee things as we are.Talmud

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attention on a computer-generated imaginary world. Amedical application is exposing burn patients to virtualrealities of glaciers, ice, snow, snowmen, and other fea-tures of a cold, cold world. Another application is toexpose a person with a fear of flying to entire virtualreality flight experiences (Hoffman, 2004). While in thefearful virtual world, patients are, at the same time,

safe in their therapist’s office.Because part of their mindknows they are safe, patientscan confront their fears inthe virtual world and learn toovercome them.

Progressive Muscle RelaxationIn the technique called progressive relaxation, you lie on your

back in quiet, comfortable surroundings with your feet slightly

apart and palms facing upward. Before beginning the exercise,

allow the thoughts of the day and any worries to leave your

mind. Then you are ready to begin.

1. Close your eyes; squeeze your lids shut as tightly as you

can. Hold them shut for a count of five, then slowly release

the tension. Notice how your eyes feel as they relax. Keep

your eyelids lightly closed; breathe slowly and deeply.

2. Turn your palms down. Bend your left hand back at the

wrist, keeping your forearm on the floor. Bend your hand

as far as it will go until you feel tension in your forearm

muscles. Hold for a count of five, then release the tension.

Notice the warm, relaxed sensation that enters your wrist.

Repeat with your right hand.

3. With palms up, make a tight fist in your left hand by

tightening the muscles of the arm and fingers. Hold for a

count of five; release the tension. Notice the tingling,

relaxed sensation in your hand and arm. Repeat with your

right hand.

4. Focus your attention on your left leg; slowly bring the top

of your foot as far forward as you can while keeping your

heel on the floor. Notice the tension in the muscles of your

lower leg. Hold for a count of five; release the tension.

Repeat with your right leg.

5. Point the toes in your left foot away from you as far as you

can. Notice the tension in your calf muscles. Release the

tension slowly. Repeat with your right foot.

Similar exercises can be performed to tense and relax other

muscles.

Managing Stress

T E R M S

hypnotherapy: the use of hypnosis to treat sickness

virtual reality therapy: use of computers to create

virtual “worlds” to engage the mind in overcoming

pain, fears, and other conditions

Meditation is notwhat you think.Krishnamurti

Table 2.3Some Myths and Facts About HypnosisCommon mythsHypnotized subjects are faking.

You must be quiet and relaxed to be hypnotized.

Hypnosis is a sleeplike state.

People with certain personalities are easy to hypnotize.

Hypnotized subjects can be made to do anything.

Under hypnosis, people remember events more accurately.

Hypnotized subjects do not remember what they did or said while

hypnotized.

Hypnotized subjects can be made to do something terrible or evil and

against their religious or moral values.

The factsBrain wave measurements and physiological responses show subjects

are not faking.

Not true. It helps, but long-distance runners and people exercising

vigorously may enter a hypnotic state.

No. Hypnotized subjects are fully aware unless they accept a suggestion

to go to sleep.

There is no correlation between personality type and hypnotizability.

Not true. Subjects will refuse to do things they find embarrassing or

immoral. They can terminate the hypnotic state at any time.

Often the opposite is the case. Testimony of hypnotized subjects

remembering events of a crime or attack is often inaccurate.

If they accept a suggestion that they will forget, which is often a part of

stage hypnosis, some may say that they forgot, but this is only

temporary.

Absolutely not true.

The software for virtual reality therapies is costly todevelop, and so is the equipment to deliver the therapeu-tic treatments. Nevertheless, virtual reality therapy hasenormous potential to be a real therapeutic mainstay.

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MeditationMeditation has been associated with both Eastern andWestern religions for centuries. Meditation is simplyfocused awareness. If you examine what is going on inyour mind at any given moment, odds are you will findit flitting from one thought to another: “Did I rememberto turn off the stove before I left the house?” “My feetare killing me; I shouldn’t have worn these shoes.” “Iwonder what mood she’s going to be in tonight?” “Didthe kids say something about going to a sleepover thisweekend?” Our minds are generally constantly activeand often involved in worrying or thinking about emo-tional upsets, financial concerns, or the pressures ofdaily activities.

Quieting the mind is healthy, and meditation is away to accomplish that. Focused awareness can beachieved in a number of ways, and there are many dif-ferent kinds of meditation. Zen meditation (zazen)involves sitting still with legs crossed while trying toempty the mind of its chatter. Transcendental meditationteaches practitioners to focus on a particular phrase(called a mantra) that is repeated internally; focusingthe mind’s attention on a single phrase excludes otherrandom thoughts. Insight meditation (Vipassana) teachesmeditators simply to observe the flow of thoughts thatpass through the mind with detachment. Buddhists,especially Tibetan Buddhists, often meditate by focus-ing their attention on a religious image (called a man-dala). Prayer is a form of meditation in that it focuses

Make Up Your Own Mantra for Changing BehaviorsUse the power of a mantra to change some aspect of

performance or behavior. Choose some behavior or activity

that you would like to change or improve. Then create your

own mantra. It should not be something complicated, but a

small thing that you feel you can achieve. It should be as

specific as possible. For example:

Sports: I feel my body getting stronger.

I feel my body moving more swiftly

through the water.

I become less tired each time around

the track.

Behaviors: I will stop eating when I feel full.

I will not speak until the anger passes.

My mind will stay alert during classes

and exams.

Be creative in designing your own mantra and spend time

each day reciting it internally while in a quiet state. You can

be a skeptic and the mantra will still work.

Health Tip

Meditation can be done anywhere, anytime.

A mandala is a complex visual image used to focus attention and facilitate

meditation. (“Green Tara,” an original painting by Maile Yawata)

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T E R M S

image visualization: use of mental images to promote

healing and change behaviors

mandala: an artistic, religious design used as an

object of meditation

mantra: a sound or phrase that is repeated in the

mind to help produce a meditative state


awareness on God. Thus, meditation is something thateveryone has experienced even if they have not called itmeditation.

Meditation does not have to be done in a religioussetting, nor is it complicated. To begin meditating, fol-low these simple suggestions:

• Choose a quiet place in your home or outside.• Find a comfortable sitting position with your back

straight. (Lying down is not recommended becauseit is strongly associated with sleep.)

• Be sure that you have at least 10 to 30 minutesduring which you will not be disturbed.

• A good way to begin meditation is to focus yourattention on breathing. Begin by becoming aware ofthe way you are breathing. Is it slow and deep? Is itquick and shallow? Is it through one nostril or both?

Gradually try to breathe by using your stomach musclesto move your diaphragm. Some people recommend the4/7/8 pattern of breathing—inhale through the nose fora count of 4, hold for a count of 7, and exhale for acount of 8 through pursed lips. If this sequence is notcomfortable, make up your own and focus on takingeach breath the same way.

Practice this meditation twice a day, particularly ifyou are upset, tired, or in pain. Once you are comfort-able with a breathing meditation, you may want toexplore other forms of meditation. Meditation hasmany documented health benefits—lowered bloodpressure, decreased heart rates, less stress, increasedblood flow, reduced pain, and relief of many chronicconditions such as asthma, arthritis, and irritable bowelsyndrome.

The faster the world becomes, the more we need toslow down.

The Power of SuggestionAnytime the mind becomes focused and relaxed, it alsobecomes more open to suggestion. This can be verybeneficial or it can create problems, depending on thekind of suggestions being received by the mind. Sugges-tions given as warnings, especially to children who areparticularly vulnerable to suggestion, can affect behav-iors and cause health problems throughout life. Forexample, here are some common admonitions given tochildren that can cause health problems because youngchildren believe what they are told.

• Put on your boots when you go out in the snow oryou will catch cold.

• If you keep eating cookies, you’ll get fat.• If you don’t try harder, you’ll be a failure in life.• If you climb those trees, you’ll fall and get hurt.• If you go out at night, the ghosts will get you.

Each of these suggestions predicts a negative outcome.To a child’s mind, which is usually in a trancelike, sug-

gestible state, these negative suggestions become fixedin the unconscious mind and may have a harmful effecteven many years later.

The mind can be made more open to suggestion bymany things we are exposed to in daily life. For exam-ple, movies and television focus attention with bothimages and sound. As a consequence, they can inducea trancelike state and cause us to cry, laugh, andbecome angry or upset; they can actually manipulateour emotions through light and sound. No one dies ona movie screen, but we often react as if they did. Theviolence and horror people watch in movies and on TVoften do affect both physical and emotional states. As aresult of watching some frightening scene, people mayactually become sick days, weeks, or years later whensomething reminds the subconscious mind of thescene and brings back the fear.

Advertisers know how to take advantage of viewers’suggestible, hypnotic states of mind. Television pro-grams usually are interrupted at an emotional peak inthe story by advertising a product while viewers are stillin a suggestible state of mind. Many people believe theyare not influenced by advertising, but marketing studiesindicate otherwise. Most advertisers try to persuadepeople to buy products they usually do not need. It isimportant to become more aware of how suggestibleyou are and to protect yourself from both obvious andsubtle suggestions that can damage your health andpeace of mind.

Image VisualizationOne of the most effective ways to promote wellness andchange undesirable behaviors is through the use ofimage visualization. Manymind–body healing tech-niques employ some form ofimage visualization. Forexample, frightening scenesfrom the past, especially fromearly childhood, can be reex-perienced while a person is ina state of mental relaxationbrought on by hypnosis or

We are what wepretend to be, so webetter be carefulwhat we pretend tobe. . . .Kurt VonnegutMother Night

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some other technique. As the scenes and emotionalupsets are visualized in the mind, they can be reinter-preted and reprogrammed to change their negativeeffects on health and behaviors. Mental imagery can alsobe used to reduce pain; hasten healing; improve perfor-mance in sports; change smoking, drinking, or eatingbehaviors; and help control compulsive urges to gamble.At one time or another in our lives, we all daydream orrun an “internal movie,” fantasizing our hopes and fears.During such fantasies we visualize experiences and cre-ate feelings. Image visualization can change body tem-perature, blood flow, heartbeat, breathing rate, produc-tion of hormones, and other body processes regulated bythe brain.

Most psychologists who work with athletes toimprove physical performance use image visualization.The so-called inner games of tennis, golf, skiing, andskating are based on image visualization. Baseball play-ers in a batting slump use relaxation and visualizationto “see” themselves getting hits. Basketball players usethe technique to “see” their free throws going cleanlythrough the hoop.

Image visualization is also the secret to improvedsexual responses and enjoyment. Sexual arousal beginsin the mind, and negative thoughts or fears can stiflethe sexual responses. The sex organs are particularlysensitive to images generated in the mind. Most sextherapists use relaxation techniques and image visuali-zation to help clients improve their sexual experiences.Tension related to sexual performance is usually themain reason for not experiencing the desired sexualsensations. In all areas of your life, begin to use your

mental powers more to enhance health and improveperformance in daily tasks.

Taking Time Out to Quiet the MindMost of us live pretty hectic lives that are full of timepressures and mental stress. Most young people eithergo to school, work at a job, or do both. In addition toschool and work, students engage in extracurricularactivities, sports, concerts, cell phone conversations,computer chat rooms, video games, movies, television—the list goes on and on. To do all these things requires ahealthy mind and body. Usually, health is somethingyoung people take for granted until it disappears. Butstaying healthy, even when you are young, means find-ing time to be quiet, to silence stressful thoughts, and toalleviate tensions in the body.

There are many ways to quiet down, and some sug-gestions and techniques have been presented in thischapter. But the best ones are the ones that you dis-cover for yourself. Find a quiet spot in a park or in youryard where you can sit and reflect on the good things inyour life. Forget for a time the problems of the worldand what you need to accomplish in life. Just noticethings around you, especially the small things. Watch-ing an ant carry a bit of food twice its size is a goodthing to do. Looking at the pattern of stars in the nightsky is a good thing to do. Experiencing the freshness ofnew snow and the taste of rain is a good thing to do.Just be quiet as often as you can. It’s good for your men-tal and physical health.

Using Your Mind to Improve Health• Become more aware of the power your mind has to improve

health, hasten healing, and help you perform better in school

and in other activities. Belief in yourself, in prayer, or in a

particular treatment can facilitate healing and help prevent

sickness.

• Use mental images that feel right to you to reduce exam

anxiety and to improve performance in sports or other

activities. Avoid negative mental images and thoughts such

as “I feel lousy,” or “I’m too tired to run,” or “I just know I can’t

do that.” Use your mind to create positive images and

thoughts. You can reverse what seems to be a “bad” day by

suggesting to yourself that things are going to change and

improve.

• Practice a daily mental relaxation technique in a place that is

comfortable and quiet. Use the time to “talk” to your body to

promote healing or to change behaviors. Visualize scenes

from the past or the future that you know are healthy and

constructive. As you become more adept at using your mind,

you will find new ways to use mental relaxation in all aspects

of your life. (Notice how we inserted a positive suggestion.)

Wellness Guide

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Critical Thinking About Health1. Identify one time in your life when you have been

seriously ill (not counting colds or minor injuries).Describe the nature of the illness and the time ittook to become well again. Discuss all of the factorsthat you think may have contributed to yourbecoming sick, including stress, emotional prob-lems, poor nutrition, and so forth. Then discuss allof the factors that you believe contributed to yourbecoming well again, including medical care,prayer, alternative medicines, and other factors.What were the most important factors that led toyour becoming sick? What were the most impor-tant ones in the healing process?

2. Find a selection of medical journals in the libraryand look at the drug company advertisements. Tryto locate ones that show a comparison of the drug’seffectiveness with a placebo. Determine how effec-tive the placebo was from the data given (usually

shown in a graph). Then compare the effectivenessof the drug with the placebo. If the placebo waseffective, explain why you think it was so effectivein this instance. Give your views on whether doc-tors should prescribe a placebo pill for some condi-tions before prescribing an active drug.

3. What is the role of religion/spirituality in health?To what degree should religion/spirituality be partof the clinical encounter between patient andphysician?

4. Describe any experiences you have had with medi-tation, hypnosis, yoga, qigong, image visualization,or any other form of mental focusing and relax-ation. Describe how you became involved with thisactivity and for what purpose you used it. Did ithelp you solve a particular health or emotionalproblem? Would you recommend this technique toothers?

Health in Review• The human mind can cause changes in body chem-

istry through thoughts and feelings, which mayhave a positive or negative effect on your health.

• Optimal health is achieved when the mind andbody communicate harmoniously.

• The unconscious regulation of all vital processes inthe body is called homeostasis.

• Disease can be regarded as disruption of homeosta-sis or disruption of the harmonious interaction ofmind and body.

• The mind and organs of the body communicatecontinuously via the autonomic nervous system,which maintains vital body functions such as heartrate, level of blood sugar, and temperature.

• Psychosomatic illnesses are physical symptomscaused by stress, anxiety, and emotional upsets.

• Somatization disorders are caused by psychosocialproblems.

• The placebo effect often is almost as powerful asdrugs in treating symptoms of illness.

• Religious activity is often associated with a health-ier lifestyle.

• Hypnosis and meditation can play a positive role inhealing illnesses.

• Belief, faith, and suggestion all have the power toheal because the mind can change disturbed bodyfunctions and reestablish homeostasis.

• A key to maintaining or improving health and well-ness is to learn and practice a mental relaxationtechnique.

• Image visualization can be used to reduce anxiety andstress, modify behaviors, and enhance performance.

• Virtual reality therapies use computer software totreat phobias and severe pain.

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Health and Wellness OnlineThe Web contains a wealth of information about healthand wellness. By accessing the Internet using Webbrowser software, you can gain a new perspective on

many topics presented in Health and Wellness, Ninth Edi-tion. Access the Jones and Bartlett Publishers Web siteat health.jbpub.com/hwonline.

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Mayberg, H. S., et al. (2002). The functional neu-roanatomy of the placebo effect. American Journal ofPsychiatry, 5, 728–735.

Mayo Clinic (2006). Biofeedback: Using your mind toimprove your health. Retrieved April 3, 2006, fromhttp://www.mayoclinic.com/health/biofeedback/SA00083.

McCauley, J., et al., (2005). Spiritual beliefs and barriersamong managed care practitioners. Journal of Reli-gion and Health, 44, 137–146.

Moseley, J. B., et al. (2002). A controlled trial of arthro-scopic surgery for osteoarthritis of the knee. NewEngland Journal of Medicine, 347, 81–88.

Musick, M. A., House, J. S., and Williams, D. R. (2004).Attendance at religious services and mortality in anational sample. Journal of Health and Social Behavior,45, 198–213.

Nash, M. R. (2001, June). The truth and hype of hypnosis.Scientific American, 37–54.

Sloan, R. P., et al. (2001). Should physicians prescribereligious activities? New England Journal of Medicine,342, 1913–1916.

Steptoe, A., Wardle, J., & Marmot, M. (2005). Positiveeffect and health-related neuroendocrine, cardio-vascular, and inflammatory processes. Proceedings ofthe National Academy of Sciences, 102, 6508–6512.

Strawbridge, W. J., et al. (2001). Religious attendanceincreases survival by improving and maintaininggood health behaviors, mental health, and socialrelationships. Annals of Behavioral Medicine, 23,68–74.

Sutherland, G., Andersen, M. B., & Morris, T. (2005).Relaxation and health-related quality of life in mul-tiple sclerosis: The example of autogenic training.Journal of Behavioral Medicine, 28, 249–256.

Thacker, P. D. (2003). Fake worlds offer real medicine.Journal of the American Medical Association, 290,2107–2112.

Wager, T. D., et al. (2004). Placebo-induced changes infMRI in the anticipation and experience of pain. Sci-ence, 303, 1162–1167.

Zsombok, T., et al. (2003). Effect of autogenic training ondrug consumption in patients with primaryheadache: An 8-month follow-up study. Headache,43, 251–257.

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Suggested ReadingsChristensen, D. (2001, February 3). Medicinal mimicry.

Science News, 74–78. Describes some of the experi-ments aimed at understanding placebo effects anddiscusses some of the concerns about their use.

Cohen, K. S. (1997). The way of qigong. New York: Ballan-tine. The definitive guide to qigong—what it is, howit works, and what it can do for you.

Hendricks, G. (1995). Conscious breathing. New York: Ban-tam Books. Explains the benefits of breathing medi-tations and describes many advanced techniquesfor practicing conscious breathing.

LeShan, L. (1999). How to meditate. Boston: Back BayBooks. A good introduction to the practice of medi-tation and its benefits.

Marks, L. (2005). Religion and bio-psycho-social health.A review and conceptual model. Journal of Religionand Health, 44, 173–186. Presents a research-basedmodel linking religious practices, spiritual beliefs,and faith community to biological, psychological,and social health.

Nash, M. R. (2001, June). The truth and hype of hypnosis.Scientific American, 37–54. A good introduction to ourscientific understanding of hypnosis.

Sternberg, E. M. (2001). The balance within: The science con-necting health and emotions. New York: Freeman. ANational Institutes of Health researcher discusseshow hormones and other molecules affect thebody’s organs and immune system. She argues thatphysicians need to pay more attention tomind–body interactions.

Thacker, P. D. (2003). Fake worlds offer real medicine.Journal of the American Medical Association, 290,2107–2112. How virtual reality therapy is being usedto treat medical problems.

Webser, J. I., Tonelli, L., & Sternberg, E. M. (2002). Neu-roendocrine regulation of immunity. Annual Reviewof Immunology, 20, 125–163. Focuses on the regula-tion of the immune response via the neuroen-docrine system, including predisposition andexpression of immune diseases, and on mecha-nisms of glucocorticoid effects on immune cells andmolecules.

Recommended Web SitesPlease visit health.jbpub.com/hwonline for links tothese Web sites.

Meditation

Descriptions of several kinds of meditation practices.

Audio Relaxation Cassettes

Dr. Emmett E. Miller presents articles on mental well-being and sells audiocassettes on image visualization,self-hypnosis, and many aspects of wellness and healing.

Study Help

The University of Toronto’s suggestions for masteringacademic skills and reducing stress from classes andstudying.

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